الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Colorectal carcinoma occurs with great variation in frequency in different parts of the world. The highest incidence appears to be in the western world, whereas a very low incidence have been reported from Africa. These variations are related not so much to racial characteristics as to environmental influence.
Although colorectal carcinoma is encountered in the older age, it is not uncommon to find the disease in younger age. Patients 39 years of age or less are classified as young adults, whereas patients above 39 years of age were class-ified as elderly.
In Egypt, colorectal carcinoma ranks 7th, of 16 inter-nationally known malignancies, preceed by the bladder lymphomas, breast, with an incidence of 8.03%. Rectal cancer was the 3rd of all digestive system carcinoma (8.03%), while colonic carcinoma was the 7th (0.7%). In western countries CRC ranks second only to those of the lungs a cause of death from cancer.
The present prospective and randomized study, was carried out over the last 4 years. It included 34 patients with CRC surgically treated of their disease in surgery department, Benha University, in an attempt to evaluate the clinicopathologic status and surgical results of patients 39 years of age or under, compared with those over 39 years of
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age. We tried to specify the factors responsible for the difference in their prognosis including clinical, investiga-tory, exploratory and pathological factors.
The whole series (34 patients), included a higher
incidence of older patients (22, accounting for 64.7%), than young adults (12, accounting for 35.5%) with CRC without statistical difference. The relatively high incidence of CRC in our young adult patients compared to that reported abroad may indicate a true high incidence of CRC in young adults in Egypt, or it may be due to the relatively small number of this series. A result which needs further investigations.
In all patients studied, females with CRC were more than males (18 and 16 patients, respectively). The older group included more females (12 patients), than males (10 patients) while both sexes were affected equally at the younger age (6 patients for each), without statistically significant difference.
The site distribution of CRC differed significantly between the two age groups. The older group included more patients with colonic carcinoma (16 cases) than the younger (4 cases), however, the younger group included more patients with rectal carcinoma (8 cases) than the older (6 cases). In the younger group the rectum (8 cases) and the right colon (2 cases) were the most common sites affected, followed by the left and sigmoid colon (one case of each). Whereas the right colon (7 cases), followed by the rectum (6 cases), the
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sigmoid colon (5 cases) and lastly the left colon were frequently affected in the older age. Colonic carcinoma was found as the disease of older females (12 cases), and rectal carcinoma for the younger males (8 cases), without statist-ically significant difference between the two groups.
Although the younger age group had a shorter, duration of the disease before operation no statistical difference was found between the two age groups.
Emergency presentation secondary to CRC was found frequently, in the older group (45.5%), than the younger (16.7%) with more malignant large bowel obstruction and peritonitis secondary to perforating tumours,without statist-ically significant difference between the two groups.
Unique histologic characteristics of CRC in young patients included a significant higher incidence for poorly differentiated adenocarcinoma which is highly malignant, and mucinous carcinoma. Such histologic differences may have been responsible in part for advanced tumour stages in our young patients. Although high incidences of lymph node involvement, peritoneal dissemination, and advanced tumour stages by a modified Dukes’ classification were present in our young
patients than the older, the difference was statistically insignificant,this may attribute to the unfavorable prognosis in young adults.
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The rate of curative resection in our young patients (50%) was slightly lower than that in the older patients (54.5%), without statistically significant difference between the two age groups. This result seems to reflect the fact that the stage of the lesion was advanced in our young patients.
Colonoscopy, barium enema, abdominal ultrasonography
were used for preoperative diagnosis of CRC and early detection of recurrence successfully. Preoperative serum CEA had a limited value in diagnosis of CRC it was used as an adjunct to clinicopathological staging of the disease.While postoperative serum CEA after resection of CRC was found as a reliable marker of recurrence, although not uniformly sensitive or specific.
The younger group showed a higher rate of local recurr-ence (50%) than the older (22.2%) especially after operations for rectal carcinoma, without a statistically significant difference between the two age groups.
Operative mortality was higher in older patients (3 cases) than younger patients (one case),without statistically significant difference. Most of these deaths resulted from medical and septic complications especially in older patients
The prognosis of the patients was evaluated on the basis of the overall 2 year survival rates in the total patients
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with resection and in those with curative resection. The overall 2 year survival rate in the younger patients was
insignificantly lower than that in the older patients (20% and 27.8%, respectively), when limited to the patients with
curative resection, also no statistically significant differ-ence was detected (33.3% and 41.7%, respectively) between the two age groups.
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CONCLUSIONS
1-Colorectal carcinoma is a disease of older age, still an increasing frequency is present in the younger patients.
2-Females are more commonly affected than males with color-ectal cancer at the older age, while both sexes are affected equally in the younger.
3-A significant difference was found between the two age groups as regards the site of colorectal cancer, with a higher incidence of colonic carcinoma in older age, and of rectal carcinoma in the young age.
4-Colonic cancer was found to be a frequent disease in older female patients, whereas rectal cancer was found to be a frequent disease in younger male patients.
5-The younger patients had commonly worse histopathological types of colorectal cancer, with a significant higher proportion of poorly differentiated and mucinous adenocar-cinoma found on histologic examination, with a higher incidence of lymph node involvement, peritoneal dissemin-ation, and advanced tumour stages by modified Dukes’class-ification than the older patients.
6-Preoperative CEA has a limited role in preoperative diagnosis of colorectal cancer. However, postoperative monitoring of CEA after resection of colorectal cancer was relatively a reliable marker of recurrent CRC.
7-Fiberoptic colonoscopy, barium enema, abdominal ultra-sonography had a useful role in the preoperative,diagnosis of colorectal cancer, and early detection of recurrence.
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8-The older patients had a better 2 year survival rate than the younger patients with CRC.
9-UnfavOrable prognosis in patients 39 years of age or less was either due to the aggressive histopathologic types of the tumours in this age, or due to delay in the diagnosis, because colorectal cancer is not usually considered in this age group, and because patients who have caecal neoplasms in this age may be diagnosed as appendiceal mass, leading to delay in the definitive treatment.
- The prognostic factors were age, sex, site of the primary lesion, type of resection and histopathologic type of the lesion.
The present study recommends that, early diagnosis and attempts at curative resection are of utmost importance in the treatment of colorectal cancer especially in young patients.